Why I Hate “Free” Healthcare
Giving things away is the best way to make them less useful and more expensive
It didn’t surprise me at all when I didn’t get a return call from my doctor. The results of the test should have been in for a week when I finally called. Nobody thought to look at them. There was no insurance company form to prompt a call to the patient. This is what happens when the customer is not the person being treated.
In twenty years of adult life, I never really needed the all inclusive health insurance policy my employers have purchased for me. I doubt that even in my most feeble year I spent anywhere near what the policy cost. In fact, there have hardly been any expenses that I could not have paid for out of pocket if I had to. In this I am fortunate. On the other hand, I have not been entirely happy with the direction my health care has gone.
When I was a child and insurance was rare, getting treated was a much simpler experience. You showed up at the doctor’s office during the hours he was in. There was not much of a support staff to help out, just a nurse that doubled as the receptionist. The two of them would work through a waiting room full of patients each afternoon. You were examined in turn and given a diagnosis of your ailment. The doctor knew you and was familiar with your medical history. If you needed medicine, the doctor might hand you a sample or write a prescription. If it was something more serious, you were sent to a specialist. There were no insurance forms required; you simply paid a fee equivalent to today’s co-pay on your way out.
This arrangement provided benefits to both parties. If I thought a doctor’s fee was too high, I could go to a doctor with a lower fee. If I didn’t like the office hours of one doctor I could find one that accommodated my schedule. The doctor set his own fee schedule and office hours. It did not take a large staff and business acumen to run a doctor’s office. With the low overhead, most of what a doctor earned went into his pocket allowing him to afford one of the nicer homes in town.
Today the purpose of a medical office is to submit insurance forms and collect insurance payments. It takes an army of office workers that fill out forms and maintain files. This overhead is a tax on our healthcare dollars and turns the insurance company into the customer. This has had the effect of eliminating my preferences from my healthcare. I have to select a doctor that takes my insurance. My doctor will perform treatments that are approved by my insurance company. My satisfaction with my doctor has little impact on his payment. I cannot shop for a doctor that is more cost effective as the doctor’s rates are negotiated with the insurance company.
These changes have made me a spectator in my health care and my doctors expert at manipulating the rules. I recently needed a medical appliance. The insurance company disagreed and I ended up buying it myself. The doctor managed to provide me with the device in only four office visits each requiring a co-pay and resulting in a bill being sent to the insurance company that was subsequently under paid. An uninsured person would have been overcharged compared to the insurance company in this situation. In other words, the uninsured are subsidizing the insured when the doctor sends them a bill. Just try sending a doctor a partial payment marked “usual and customary charge, paid in full” like the insurance companies do.
This is what you get when you don’t pay your own way. The quality of service deteriorates and the cost spirals out of control. This is a fairly simple life experience. That so many people want to address healthcare costs by further removing the patient from the payer proves that thinking and learning are harder that acquiescing.
The standard “progressive” methods for addressing healthcare costs are to either create a single payer system (an interesting euphemism for a government run system which ironically would result in everyone paying) or force businesses to cover more employees with more comprehensive policies. Either solution is going to create more inflation and reduced service. The only way to improve the US healthcare system is to reduce demand relative to supply. You can’t do that with more insurance. You do it by tying what a doctor earns to the number of patients he treats instead of which insurance companies’ forms he can process.